POS0074-HPR EFFICACY OF E-CONSULTS COMPARED TO IN-PERSON REFERRALS OF ANA POSITIVE PATIENTS TO RHEUMATOLOGY CLINIC
Authors: J. Par-Young, J. Young, F. Kennedy, I. Kang, X. Dong
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Antinuclear antibodies (ANA) are autoantibodies associated with several autoimmune diseases but are also present in healthy individuals due to their role in the body's biological immune response. Thus, testing for ANA in an ambulatory setting could be inappropriately ordered and misinterpreted. Yet, delay in proper management of patients with rheumatologic presentations could result in increased morbidity and health care expenditure. Electronic consultation, or eConsults, could be utilized by primary care providers (PCPs) as a convenient tool to expedite access to rheumatology specialists and optimize care. <h3>Objectives</h3> To assess the efficacy of eConsults in terms of resource utilization and time to referral when compared to in-person referrals of ANA+ patients. <h3>Methods</h3> In this retrospective cohort study, we reviewed the charts of 131 ANA+ patients within the Yale New Haven Health System seen from August 2019 to September 2022. The charts were divided into cases referred by eConsult and by in-person referrals. Time from chart order to eConsult or in-person consultation, diagnosis after consult completion, and laboratory workup results were evaluated. Relative risks (RR) were calculated to compare the efficacy of eConsults vs. in-person referrals in diagnosing connective tissue diseases (CTD) and initiating appropriate referrals. A chi-square test of independence was conducted to determine if there was an association between ESR/CRP levels and conversion to in-person follow-up appointments in eConsult patients. <h3>Results</h3> Among the 131 ANA+ patients seen by their PCPs, 91 (69.5%) were referred through eConsult and 40 (30.5%) were in-person referrals to a rheumatologist. The average time from the initial eConsult request to completion of the consult was 1.46 ± 2.54 days while in-person consults required longer wait times of 76.63 ± 48.61 days. <h3>Conclusion</h3> Electronic consultation is an easy and timely method for referral to the rheumatology clinic. In this study, ANA+ patients requiring an urgent consultation were identified earlier through an eConsult compared to an in-person referral. eConsults were also capable of identifying cases that required specialist treatment; 80.9% of patients that weren't referred would not receive a CTD diagnosis in the future. Thus, eConsults should be considered an effective and efficient tool in properly referring patients with rheumatologic presentations and parsing out cases that would not require specialist care. <h3>References</h3> [1]Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults' Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol. 2022 Apr 1;28(3):147-154. [2]Abeles AM, Abeles M. The clinical utility of a positive antinuclear antibody test result. Am J Med. 2013 Apr;126(4):342-8. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.